Medical and cosmetic treatments to improve the appearance of the person, to solve problems related to skin blemishes and also to deal with and solve situations of true psychological distress deriving from the subject's inability to accept his or her appearance, are becoming increasingly widely used.
Among the various procedures, methods and machines used, a vast number of cases are dedicated to treatments aimed at reducing the effects of aging and, therefore, in particular, at eliminating or reducing the formation of wrinkles on the face and on other parts of the body, such as the neck and the upper part of the chest. In recent times, techniques have been developed for treating the epidermis using laser. In many applications, the portion of epidermis to be treated is irradiated in a practically uniform manner by a laser beam, which performs a surface ablation process, with consequent elimination of the upper layers of the epidermis.
The use of the laser in treatment of the epidermis, especially of the face, to reduce wrinkles and other skin blemishes is described, among others, in the following works: Chernoff G, Slatkine M, Zair AND, Mead D., “SilkTouch: a new technology for skin resurfacing in aesthetic surgery”, in J Clin Laser Med Surg. 1995 April; 13(2):97-100; Waldorf H A, Kauvar A N, Geronemus R G; “Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients.”, in Dermatol Surg. 1995 November; 21(11):940-6; David L M, Same A J, Unger W P., “Rapid laser scanning for facial resurfacing.”, in Dermatol Surg. 1995 December; 21(12):1031-3; Lask G, Keller G, Lowe N, Gormley D., “Laser skin resurfacing with the SilkTouch flashscanner for facial rhytides.”, in Dermatol Surg. 1995 December; 21(12):1021-4; Apfelberg D B., “Ultrapulse carbon dioxide laser with CPG scanner for full-face resurfacing for rhytids, photoaging, and acne scars”, in Plast Reconstr Surg. 1997 June; 99(7):1817-25; Apfelberg D B, Smoller B. “UltraPulse carbon dioxide laser with CPG scanner for deepithelialization: clinical and histologic study”, in Plast Reconstr Surg. 1997 June; 99(7):2089-94; Raulin C, Drommer R B, Schönermark M P, Werner S., “Facial wrinkles—ultrapulsed CO2 laser: alternative or supplement to surgical face lift?”, in Laryngorhinootologie. 1997 June; 76(6):351-7; Trelles M A, Rigau J, Mellor T K, García L., “A clinical and histological comparison of flashscanning versus pulsed technology in carbon dioxide laser facial skin resurfacing”, in Dermatol Surg. 1998 January; 24(1):43-9; Weinstein C., “Computerized scanning erbium:YAG laser for skin resurfacing”, in Dermatol Surg. 1998 January; 24(1):83-9; Bernstein L J, Kauvar A N, Grossman M C, Geronemus R G., “Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers”, in Dermatol Surg. 1998 January; 24(1):101-7; Vaïsse V, Clerici T, Fusade T., “Bowen disease treated with scanned pulsed high energy CO2 laser. Follow-up of 6 cases”, in Ann. Dermatol. Venereol. 2001 November; 128(11):1220-4.
In recent times, methods have been developed in which treatment of the epidermis is discontinuous (known as “fractional” technology), i.e. on a given region to be treated the laser is focused in discrete areas, separated from one another by areas that are not irradiated by the laser beam. The zones irradiated by the laser beam are subjected to ablation in substantially cylindrical volumes, spaced apart from one another by large volumes in which no treatment is carried out. Methods of this type are described in Toshio Ohshiro et al, “Laser Dermatology—State of the Art”, proceedings of the 7th Congress International Society for Laser Surgery and Medicine in Connection with Laser 87 Optoelectronics, ed. Springer-Verlag, 1988, page 513 ff. The same methods are described in U.S. Pat. No. 6,997,923.
In this way, attempts are made to combine the requirement of tissue ablation, which causes localized damage of the tissue and erythema due to the noteworthy heating produced by the laser, with the need for a minimally invasive procedure. It was deemed that by acting on limited tissue portions spaced apart from one another by wide zones not affected in by the laser beam, it would be possible to obtain treatment effects (such as reduction or elimination of wrinkles) equivalent to those obtained with a full volume or full surface area treatment of conventional type, but with fewer secondary effects of damage to the epidermis, a decrease in the formation of erythema and in general a reduction in post-treatment recovery times.
In the literature, procedures of this type are described, among others, in the following works: Fitzpatrick R E, Rostan E F, Marchell N., “Collagen tightening induced by carbon dioxide laser versus erbium: YAG laser”, in Lasers Surg. Med. 2000; 27(5):395-403; Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S., “Clinical trial of a laser device called fractional photothermolysis system for acne scars”, in Dermatol. 2006 September; 33(9):623-7; Rahman Z, Alam M, Dover J S., “Fractional Laser treatment for pigmentation and texture improvement”, in Skin Therapy Lett. 2006 November; 11(9):7-11; Laubach H, Chan H H, Rius F, Anderson R R, Manstein D., “Effects of skin temperature on lesion size in fractional photothermolysis”, in Lasers Surg Med. 2007 January; 39(1):14-8; Collawn S S., “Fraxel skin resurfacing”, in Ann Plast Surg. 2007 March; 58(3):237-40; Hantash B M, Bedi V P, Chan K F, Zachary C B., “Ex vivo histological characterization of a novel ablative fractional resurfacing device”, in Lasers Surg Med. 2007 February; 39(2):87-95; Hantash B M, Bedi V P, Kapadia B, Rahman Z, Jiang K, Tanner H, Chan K F., “In vivo histological evaluation of a novel ablative fractional resurfacing device”, in Lasers Surg Med. 2007 February; 39(2):96-107.
The efficacy of these methods is debatable. In particular, acting on volumes that are too close together it is not possible to obtain particular improvements in terms of reduction of recovery times, while treating volumes that are spaced too far from one another by untreated zones involves the risk of insufficient results and consequent need for a second treatment.
The use of radiofrequency current is also known in aesthetic treatments. See for example Goldberg D J, Fazeli A, Berlin A L. “Clinical, laboratory, and MRI analysis of cellulite treatment with a unipolar radiofrequency device”, in Dermatol Surg. 2008 February; 34(2):204-9; or Montesi G, Calvieri S, Balzani A, Gold M H., “Bipolar radiofrequency in the treatment of dermatologic imperfections: clinicopathological and immunohistochemical aspects”, in J. Drugs Dermatol. 2007 February; 6(2):212-5.
WO-A-02/26147 and U.S. Pat. No. 6,702,808 describe a system for treatment of the epidermis in which a radiofrequency current is combined with optical energy. The treatment described in this publication provides for the simultaneous application of optical and radiofrequency radiation. The characteristics of the optical radiation used are not described in detail, although it is indicated that their wavelength (λ) must be no greater than 1200 nm.